There are perhaps as many cancer stories as people with cancer.  There are also many ways of telling them – but a musical is one of the more risky.  A Pacifist’s Guide to the War on Cancer is described as “an all-singing, all-dancing examination of life with a cancer diagnosis”, with an aim of revealing the ‘truths’ buried under the military metaphors that still surround cancer.  The production, the result of a collaboration between  Bryony Kimmings and Complicite Associates, certainly deftly skewers much of the baggage that a cancer diagnosis carries with it: the urgings to be positive, the war on cancer, the brave struggles, the concerned ‘cancer face’ of friends who don’t know what to say and (in a nice theatrical touch) the fear of the ‘blob’ displacing the body.

The story centres on a day in the life of Emma (Amanda Hadingue), a mother whose baby is being tested for cancer,  as she navigates opaque hospital procedures, denial, and the doctor’s breaking of bad news –  delivered, largely unheard, except for words like ‘statistical’ and ‘decision’,  through distortion.  Shepherding her ‘journey’ (so hard to avoid those cancer metaphors) to the ‘land of the sick’ is a chorus of those with and affected by cancer, all drawing (as does the character of Emma) on the stories of real people.  These chorus members are also, though, economically conjured up by a fantastic cast as individuals, whose fates we care about by the end of the first half.

So does A Pacifist’s Guide  work as musical?  Mostly, yes.  Laughter and tears? Check. Big showstoppers and lively dance numbers? Check.  Still humming the theme tune on the way out of the theatre? Check. Indeed irritatingly so all the next day too.  There are strong performances from an excellent cast, including Naana Agyei-Ampadu as ‘Gia’, resisting the onslaught of affirmative images, and Rose Shalloo as Shannon, a young pregnant woman with a hereditary cancer disorder. The second half frays a little towards the end, moving from theatre to group therapy, as the cast break the fourth wall (oh, heavens, it is impossible to avoid metaphors) to engage directly with both the off-stage voice of Bryony Kimmings and the words of the ‘real’ people behind the stories, voiced by the actors playing them.  Finally, the voice of Bryony interacts with the audience.  Although not quite as toe-curling as it could be, this breaching of theatrical convention somewhat undercuts the claims of the first half.  If musical theatre can tell true stories of cancer; why do we need even ‘truer’ stories of real people?  It is as if faith in the medium, or courage, failed at the last moment.

And what of the consciousness raising aims of revealing the truth beneath the metaphors?  Inevitably, the show draws on Susan Sontag, whose 1978 essay Illness as Metaphor argued that cancer, like tuberculosis in previous centuries, was “encumbered by the trappings of metaphor”. The words we use to describe it, such as the geographical metaphors of spread and diffusion, and the military metaphors of battle, victim and crusade, Sontag suggested, contributed to the popular framing of cancer as a moralistic consequence of some personal failing: being the kind of person who got cancer, at that time, she suggested, was someone who repressed emotions.  Further, cancer functioned as a powerful political metaphor: “To describe a phenomenon as a cancer is an incitement to violence”.  Unlike other diseases, cancer was somehow “felt to be obscene—in the original meaning of that word: ill-omened, abominable, repugnant to the senses” and those with cancer could find themselves lied to, avoided, and stigmatised.  Times have changed since Sontag was writing: we lie less often to those diagnosed; there is no longer an assumption that cancer is a death sentence; and we rarely refer obliquely to the ‘Big C’.  Arguably, rather than silence, we are now surrounded by cancer talk, coloured ribbons, and charity fun runs.

But, as Kimmings’ show entertainingly demonstrates, despite this surfeit of imagery, mostly we remain unprepared for a diagnosis of cancer.   In terms of support – for the practical problems, for the bodily malfunctions, for the tiredness, for the existential uncertainty of ‘why me, why now?’ –  society offers little more than when Sontag was writing.  Those with cancer are still thrust into what Sontag called the ‘land of the sick’, and this is a strange new world in which pink ribbons, positivity and hushed tones may hinder not help.  On positive thinking, for instance,  Wilkinson and Kitzinger’s study of how women with breast cancer actually talk about ‘thinking positive’ looked carefully at when it was said, in what contexts, and with what effects. They concluded that rather than reflecting inner feelings of ‘positivity’, uttering the phrase was a conversational idiom – an expression of what was socially acceptable, to move on from difficult subjects in conversation, or as a rider at the end of descriptions of distressing experiences to avoid embarrassing other people.

If all we have to offer are exhortations to think positively, and engage in sponsored-athons wearing pink ribbons whilst waging ‘war on cancer’, then the essence of Sontag’s argument still applies, and A Pacifist’s Guide to the War on Cancer is a necessary (and entertaining) reminder to be critical of those cancer clichés that are so easy to reach for.  It seems churlish, then, to suggest that the message is hardly original; that we have long known that cancer is surrounded by metaphor.   They may be impossible to erase completely:  we cannot tell cancer story, or indeed any stories, without them. But this show does suggest that we might need a refresh, as our current ones are leaving some stories hard to tell, and hard to hear.  We need some new metaphors to help tell ‘real’ stories of messy, uncertain bodies, that might die sooner rather than later, and are as likely to be angry, sad or stoic as positive.

A Pacifist’s Guide to the War on Cancer is at the Dorfman Theatre, London, until November 29th.